REPORT ON MIDWIFERY, DISEASES OF WOMEN, AND DISEASES OF CHILDREN.

By ALFRED WILTSHIRE, M.D., M.R.C.P. Lond.,

Joint Lecturer on Midwifery at St. Mary's Hospital; Honorary Secretary to, and Member of, the Council of the Obstetrical Society of London; formerly Medical Inspector to Her Majesty's Privy Council, &c.

MIDWIFERY.

By Dr. KASSOWITZ

By Prof. BISCHOFF

1. The Hereditary Transmission of Syphilis. (Stricker's Jahrbucher,' Part iv, 1876). 2. On the Prophylaxis of Puerperal Fever. ('Allg. Med. Cent. Zeit.,' Feb., 1876). 3. Cases of Puerperal Fever with reference to Epidemic Origin. By Dr. BRUCE (Edin. Med. Journ.,' July, 1876).

4. A case of Primary Abdominal (Extra-Uterine) Pregnancy. By Dr. SCHMITT (Memorabilien,' 1874).

5. Three cases of Stone in the Bladder complicating Pregnancy. By Dr. HUGENBERGER (St. Petersburger Med. Zeitsch.,' vol. v,

1875).

6. Embolism of the Pulmonary Artery, following the application of Esmarch's bandage to the lower limbs. By Dr. MASSARI (Wien. Med. Woch.,' No. 48, 1875).

7. On Syphilitic Manifestations in Pregnant and newly delivered Women. By Dr. MORET (Thèse de Paris,' 1875, Delahaye). 8. The Originator of the Double-curved Midwifery Forceps. By Dr. MCCLINTOCK (Dublin Obstetrical Society,' April 8th, 1876).

9. Fibro-Myoma in the Vesico-Vaginal space obstructing Delivery; spontaneous expulsion; artificial enucleation; recovery. By Dr. EDUARDO PERRO (Ann. de Gynec.,' Jan., 1876). 10. Dropsy of the Amnion-Twin Pregnancy. By Dr. LE ROY de Langevinière (L'Année Médicale,' July, 1876).

1. Dr. Kassowitz gives the results of his observations at the Vienna Childrens' Hospital, where he had unusual opportunities for investigation the subject of the hereditary transmission of syphilis.

He found that infection by the sperm-cell or germ-cell, or both, was the common method.

A healthy mother might bear a syphilitic child without herself becoming infected; and further, a mother who became infected with syphilis after conception of a healthy child could not infect the child.

It is stated, however, that the mother's syphilis may cause abortion, although the ovum is not syphilised. Syphilis, in fact, is said. to be transmissible to the offspring by either parent only at the time of conception.

It would seem that the syphilitic virus differs from that of smallpox, scarlet fever, &c., inasmuch as it is incapable of transmission through the placental tissues, i. e., the syphilised foetus cannot infect a healthy mother, nor a syphilised mother a healthy fœtus through this channel.

[There seems to be evidence from the pathology of the nervous structures that mothers who bear syphilitic children without themselves displaying the ordinary phenomena of syphilis are liable to cerebral and spinal lesions at periods long remote from the time of the infecting pregnancy. I believe that the experience of Dr. Broadbent substantiates this.-Rep.]

2. Believing that puerperal fever, in its manifold forms, arises only from infection through wounds of the genital canal, chiefly carried into the parts from without, though occasionally autogenetic, Professor Bischoff strongly recommends the free use of carbolic acid during all labours; baths and injections containing it being given, and the hands and all instruments are washed in a three per cent. solution of the acid, or a preparation containing ten per cent. in oil or glycerine.

All lacerations should be united, where practicable, by carbolised silk, or by silver wire. After labour, injections of a two per cent. solution of carbolic acid should be used, and if a catheter is used it should be anointed with carbolised oil. Statistics are given, showing a greatly lessened rate of mortality since the use of carbolic acid.

3. Dr. Bruce relates his experience of puerperal fever, so called, for a period of twenty-one years, during which time he attended 3500 cases, of which twenty-two presented symptoms referable to puerperal fever. Small-pox and scarlet fever accounted for six, and of the rest the causes were various, the majority being grouped under the heading "unknown."

Dr. Bruce states that his experience entirely accords with that of Dr. Matthews Duncan, who, at the beginning of this year, read a paper before the Obstetrical Society of Edinburgh to disprove the assertion that occasional outbreaks of puerperal fever occurred in an epidemic form.

4. In this case of extra-uterine gestation the foetus was developed within the peritoneal cavity and the pregnancy had passed the term by a month according to the patient's belief.

Nothing abnormal had been observed during the pregnancy, but the day Dr. Schmitt saw the patient she complained of severe pains of an expulsive character. Some hours later the foetus was living, as was proved by the existence of foetal heart sounds. While Dr. Schmitt was examining the patient a bag which projected considerably into the vagina suddenly burst and gave exit to a quantity of foetid fluid. With this came the right arm of the child. Turning having been found to be impossible, even under chloroform, the patient died undelivered during convulsions.

At the autopsy the foetus was found to be without envelopes; the placenta was attached to the mesentery; all the organs were normal except at the seat of rupture in the vagina.

5. Dr. Hugenberger gives the particulars of three very interesting cases of stone in the female bladder, all occurring during pregnancy, and two complicating delivery.

In the first case delivery was ultimately accomplished by means of the forceps without the removal of the stone, and the patient recovered. In the second case labour pains were excited prematurely, and on examination a stone was found in the bladder and was removed by vaginal lithotomy. After this the labour pains went off for fifteen days, when they came on again, and the patient was delivered in about the thirty-fourth week of her pregnancy. Rigors and fever set in from this time and she died with symptoms of peritonitis. Chronic interstitial nephritis, pyelitis and purulent collections around the uterus were found.

The third case was that of a primipara who had had retention of urine ever since her labour set in. On examination a stone was found to obstruct the descent of the head and also the passage of urine. Vaginal lithotomy was performed and an hour afterwards delivery occurred spontaneously. Three days subsequently the patient died of septic peritonitis. Post-mortem; the kidneys were found to be enormously enlarged and soft. There was also pyelitis and chronic cystitis.

6. A patient who had had ten deliveries without accidents was brought to Professor Spaeth's clinique in the sixth month of her eleventh pregnancy on account of uterine hemorrhage. The patient was so anæmic that labour was induced by Braun's colpeurynter and completed by turning. Though there was but little hæmorrhage symptoms of collapse came on. For this the lower limbs were enveloped in Esmarch's bandage from the great toes up to the upper third of the thighs. After this the pulse returned, dyspnoea diminished and the general state improved so that the patient took nourishment.

Three times in the course of two days the bandages became so painful that it was necessary to undo them, but they were re-applied on account of the recurrence of the symptoms of depression. On the following day as the bandage was being removed from the left leg the patient fell over, the face became pale, the extremities cold and the pulse imperceptible. The agony lasted two hours, during which there was irregularity of the heart, extreme dyspnoea, and ultimately stertorous breathing. Post-mortem, several clots were found adherent to the internal tunic of, and likewise blocking, branches of the third order of the pulmonary artery. Similar clots filled the saphenous vein and its branches in both limbs.

7. Dr. Moret's thesis is divided into three parts. In the first he has studied the influence of pregnancy on the appearance of syphilitic manifestations, and he finds it is often the occasion of them; in support of which he adduces a number of observations showing that each pregnancy in certain women affected with syphilis was attended by syphilitic eruptions on the skin or mucous membranes.

In the second part Dr. Moret studies the grave influence of pregnancy on syphilis. In the pregnant woman the syphilitic fever

is longer and more intense; the eruptions of mucous tubercle on the genital organs are more confluent. The same statements hold good with regard to the various syphilides which may be seated about the anus, vulva, and perinæum. Syphilitic rheumatism is more acute, and is accompanied by more pain and by more intense fever. Tertiary symptoms come on early and anticipate the secondary accidents. The third part of the thesis is devoted to treatment, but there is nothing specially calling for comment, as the treatment is the same whether the patient be pregnant or no.

8. Dr. McClintock has lately inquired into the history of the double curved forceps, with the purpose of ascertaining to whom the credit of inventing the second, or pelvic, curve belongs. His learned investigations show that the first person who devised and made use of this form of forceps was Dr. Benjamin Pugh, of Chelmsford, Essex, who had the instrument made about the year 1736. But both Levret and Smellie also had a similar instrument in use about the same time-Levret in 1747 and Smellie in 1751. It is possible that the idea of a pelvic curve occurred to each of those eminent men independently, for there is no evidence to show that they were acquainted with the previous discovery of the instrument.

9. This is a remarkable case. The patient, a primipara, was in the Maternity Hospital at Milan. When she fell in labour it was found that although the pelvis was normal, there was a mass in the anterior part of the vagina which descended before the foetal head. The patient's condition being favorable it was decided to wait, and it was found that the mass descended so as ultimately to come below the vulva, and it then became fixed below the pubic arch. The The foetal head soon followed, but it was found that when fully born the child was dead.

Nothing was done to the mass until the third day, when the vaginal wall covering it was found to be getting into a gangrenous state. Incisions were then made, and the mass was enucleated without any pedicle being found. The growth was supposed to have been originally sub-peritoneal and behind the bladder. The patient made a good recovery.

10. The patient, a multipara, supposed herself to be six or seven months pregnant, but she suddenly began to have rapid enlargement of the abdomen, and at the end of seven months she was larger than if at full term. The abdomen was very tense; fluctuation was marked; there were some uterine contractions however, and fœtal movements and heart sounds were observed. Labour set in with escape of water two months before the expected time, and before the os was dilated, so that the accoucheur prevented the sudden and complete escape of the fluid by plugging the os with his finger. In this way he controlled the labour until the contractions became regular. The patient recovered.

[A very similar case has lately occurred in my practice.—Rep.]

DISEASES OF WOMEN.

1. On Incision and Dis-cission of the Cervix-uteri. By Dr. E. R. PEASLEE (Amer. Journ. of Obstetrics,' August, 1876). By Dr. FORDYCE BARKER

2. Vaginal Hernia, or Enterocele.

(Amer. Journ. of Obst.,' June, 1876).

3. Formation of an Artificial Ureter for Urinary Fistula arising after Ovariotomy. By Prof. Von NUSSBAUM ('Edin. Meď. Journal,' July, 1876).

4. On the Pathology of Membranous Dysmenorrhoea. By Dr. BEIGEL (Arch. f. Gynæk.,' Band ix, heft i, 1876).

5. On the differential diagnosis of Sub-peritoneal Serous Cysts and Ovarian Cysts. By Dr. KŒBERLE (Gaz. Méd. de Strasbourg,' No. 1, 1876).

6. Retention of Menses in one half of a Double Genital Canal (Hæmato-colpometra Laterale). By Dr. FABBRI (Lo Sperimentale,' Feb., 1876).

7. Spontaneous Rupture of an Ovarian Cyst. By Dr. KRYZAN ('Centr. f. Chir.,' No. 1, 1876).

8. Carcinoma of the Ovary, Umbilicus, and Sternum. By Dr. KüsTER (Beiträge zur Geburts. und Gynæk.,' Band vi, heft 1, 1875).

9. Cancerous degeneration of both Ovaries during Pregnancy. By Dr. HEMPEL (Arch. f. Gynæk.,' Band vii, heft 3, 1875). 10. Amputation of the body of the Uterus in a case of inversion; recovery. By Dr. PALASCIANO (Arch. di Chir. Pr.,' vol. xii). 11. Remarks on the Enucleation of Uterine Fibroids. By Dr. GAILLARD THOMAS ('American Archives of Clin. Surg.,' July, 1876).

1. Dr. Peaslee read an elaborate and able paper on this subject before the New York Academy of Medicine on June the first of the present year.

Dr. Peaslee comments severely on the operations proposed and practised by the late Sir James Simpson and by Dr. Marion Sims, and points out their dangers, viz. hæmorrhage, pelvic cellulitis, septic peritonitis, abortion, and sterility; such dangers arising mainly from the extent of the incisions.

Admitting that enlargement of the calibre of the internal os is indicated in certain cases of dysmenorrhoea, &c., Dr. Peaslee advises an operation which greatly limits the extent of the incision. This small operation is preferable for certain reasons to the slow and possibly painful method of dilatation.

The operation recommended by Dr. Peaslee should not be undertaken if a sound, one eighth of an inch in diameter or more, could be passed through the internal os; the obstruction arising from stenosis and not from flexion. If the external os would only admit a sound one sixth of an inch in diameter stenosis as regards conception probably existed and an operation might become necessary.